1326083361 NPI number — JAMES G HUBBARD M.D.

Table of content: JAMES G HUBBARD M.D. (NPI 1326083361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326083361 NPI number — JAMES G HUBBARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBBARD
Provider First Name:
JAMES
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326083361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2003 BLUEGRASS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEYENNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82009-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-634-7711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E 20TH ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82001-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-634-7711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4525A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 29468 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 21266 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 91045252 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 306014 . This is a "BCBS WYOMING" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 104805800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".